Amount: Name: Address: City: State: Postal Code: Phone: Email: Country: Select Country Aruba Afghanistan Angola Anguilla Åland Islands Albania Andorra Netherlands Antilles United Arab Emirates Argentina Armenia American Samoa Antarctica French Southern Territories Antigua and Barbuda Australia Austria Azerbaijan Burundi Belgium Benin Burkina Faso Bangladesh Bulgaria Bahrain Bahamas Bosnia and Herzegovina Saint Barthélemy Belarus Belize Bermuda Bolivia Brazil Barbados Brunei Darussalam Bhutan Bouvet Island Botswana Central African Republic Canada Cocos (Keeling) Islands Switzerland Chile China Côte d`Ivoire Cameroon Congo, the Democratic Republic of the Congo Cook Islands Colombia Comoros Cape Verde Costa Rica Cuba Christmas Island Cayman Islands Cyprus Czech Republic Germany Djibouti Dominica Denmark Dominican Republic Algeria Ecuador Egypt Eritrea Western Sahara Spain Estonia Ethiopia Finland Fiji Falkland Islands (Malvinas) France Faroe Islands Micronesia, Federated States of Gabon United Kingdom Georgia Guernsey Ghana N Guinea Gibraltar Guadeloupe Gambia Guinea-Bissau Equatorial Guinea Greece Grenada Greenland Guatemala French Guiana Guam Guyana Hong Kong Heard Island and McDonald Islands Honduras Croatia Haiti Hungary Indonesia Isle of Man India British Indian Ocean Territory Ireland Iran, Islamic Republic of Iraq Iceland Israel Italy Jamaica Jersey Jordan Japan Kazakhstan Kenya Kyrgyzstan Cambodia Kiribati Saint Kitts and Nevis Korea, Republic of Kuwait Lao People`s Democratic Republic Lebanon Liberia Libyan Arab Jamahiriya Saint Lucia Liechtenstein Sri Lanka Lesotho Lithuania Luxembourg Latvia Macao Saint Martin (French part) Morocco Monaco Moldova Madagascar Maldives Mexico Marshall Islands Macedonia, the former Yugoslav Republic of Mali Malta Myanmar Montenegro Mongolia Northern Mariana Islands Mozambique Mauritania Montserrat Martinique Mauritius Malawi Malaysia Mayotte Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua R Norway Niue Netherlands Nepal Nauru New Zealand Oman Pakistan Panama Pitcairn Peru Philippines Palau Papua New Guinea Poland Puerto Rico Korea, Democratic People`s Republic of Portugal Paraguay Palestinian Territory, Occupied French Polynesia Qatar Réunion Romania Russian Federation Rwanda Saudi Arabia Sudan Senegal Singapore South Georgia and the South Sandwich Islands Saint Helena Svalbard and Jan Mayen Solomon Islands Sierra Leone El Salvador San Marino Somalia Saint Pierre and Miquelon Serbia Sao Tome and Principe Suriname Slovakia Slovenia Sweden Swaziland Seychelles Syrian Arab Republic Turks and Caicos Islands Chad Togo Thailand Tajikistan Tokelau Turkmenistan Timor-Leste Tonga Trinidad and Tobago Tunisia Turkey Tuvalu Taiwan, Province of China Tanzania, United Republic of Uganda Ukraine United States Minor Outlying Islands Uruguay United States Uzbekistan Holy See (Vatican City State) Saint Vincent and the Grenadines Venezuela Virgin Islands, British Virgin Islands, U.S. Viet Nam Vanuatu Wallis and Futuna Samoa Yemen South Africa Zambia Zimbabwe
